Obama's Key Health Reforms Hang In Balance

Barack Obama's signature achievement, a law-reforming healthcare in America, hangs in the balance with a Supreme Court decision on its fate due this week.

The Affordable Care Act, known as 'Obamacare' to its opponents, had two central aims - to reduce rocketing healthcare costs and expand the number of people with health insurance.

Ron Pollak, from US health advocacy, says the fact that as many as 50 million Americans have no health insurance is extraordinary.

"We pay more for healthcare as a nation by far than any other country in the world and yet one sixth of our nation doesn't have health coverage," he said.

"In the Western world, how can you explain this?"

America's healthcare system is notoriously dysfunctional. While it delivers excellent care to those who can afford it, many have been left out, including many of the poor and the chronically ill.

The ACA was designed to address many of those issues. But it was challenged by Republican opponents, at first in public meetings, then in Congress where intense wrangling watered down some of its key provisions.

Its opponents then took their battle to the courts. They say the reforms are unconstitutional because they force Americans who can afford health insurance to have health insurance.

Two years ago, few legal scholars believed that challenge would be taken seriously but that has changed.

Three months ago, Supreme Court justices heard oral arguments questioning the constitutional validity of 'Obamacare'.

The tone of questioning by some of the more conservative justices led many observers to believe the reforms may be in trouble.

Ron Pollack told Sky News he fears politics is now guiding America's highest court more than the law.

"If this case is decided on a five to four partisan line, I think it undermines the confidence the public has about the Supreme Court as an objective arbiter of difficult legal decisions," he said.

The Supreme Court could strike down the whole law, though that is thought highly unlikely. Many of the reforms are likely to survive but some fundamental elements are thought vulnerable to removal by justices.

Legal and health experts differ on how fatal a blow that would deal the reforms as a whole.

If the Supreme Court does knock the heart out of the law, it will be a stunning reversal for Mr Obama and a huge blow for the tens of millions without health insurance.

He says he has no plan B and his Republican rivals seem to have no substantial alternative either.